§1396w–3 — Title 42 The Public Health and Welfare | U.S. Code

Summary

Require States to give people an easy online way to apply for, enroll in, and renew Medicaid or CHIP, and to sign electronically. The State must have a website linked to its health insurance Exchange (section 18031) and to the CHIP office by January 1, 2014. The site must let users compare benefits, premiums, and cost-sharing between Medicaid or a waiver and Exchange plans, including how a child would be covered in family or supplemental plans. If the Exchange identifies someone as eligible for Medicaid, CHIP, or premium tax credits, the State must enroll them through the website without more paperwork. If someone is found ineligible for Medicaid or CHIP, the State must check them for eligibility for Exchange plans and for premium assistance under section 36B (and advance payments under section 18082), enroll them if eligible, and give information about reduced cost-sharing under section 18071 and other help. The State Medicaid agency (the office that runs Medicaid) and the State CHIP agency (the office that runs CHIP) must use a secure electronic system with the Exchange to determine eligibility and enroll people. They must coordinate care for people enrolled in both Medicaid/CHIP and an Exchange plan, and do outreach to vulnerable groups (for example, children, homeless youth, pregnant women, people with disabilities, and those with mental health or substance use disorders). The State may agree with the Exchange to determine premium assistance if Treasury rules are met, and must participate in the system under section 18083. This does not change the State’s duty to assess people for home and community-based services under subsection (a)(10)(A)(ii)(VI) of section 1396a.

Title 42, §1396w–3

The Public Health and Welfare — Source: USLM XML via OLRC

(a)As a condition of the State plan under this subchapter and receipt of any Federal financial assistance under section 1396b(a) of this title for calendar quarters beginning after January 1, 2014, a State shall ensure that the requirements of subsection (b) is 11 So in original. Probably should be “are”. met.

(b)(1)A State shall establish procedures for—

(A)enabling individuals, through an Internet website that meets the requirements of paragraph (4), to apply for medical assistance under the State plan or under a waiver of the plan, to be enrolled in the State plan or waiver, to renew their enrollment in the plan or waiver, and to consent to enrollment or reenrollment in the State plan through electronic signature;

(B)enrolling, without any further determination by the State and through such website, individuals who are identified by an Exchange established by the State under section 18031 of this title as being eligible for—

(i)medical assistance under the State plan or under a waiver of the plan; or

(ii)child health assistance under the State child health plan under subchapter XXI;

(C)ensuring that individuals who apply for but are determined to be ineligible for medical assistance under the State plan or a waiver or ineligible for child health assistance under the State child health plan under subchapter XXI, are screened for eligibility for enrollment in qualified health plans offered through such an Exchange and, if applicable, premium assistance for the purchase of a qualified health plan under section 36B of the Internal Revenue Code of 1986 (and, if applicable, advance payment of such assistance under section 18082 of this title), and, if eligible, enrolled in such a plan without having to submit an additional or separate application, and that such individuals receive information regarding reduced cost-sharing for eligible individuals under section 18071 of this title, and any other assistance or subsidies available for coverage obtained through the Exchange;

(D)ensuring that the State agency responsible for administering the State plan under this subchapter (in this section referred to as the “State Medicaid agency”), the State agency responsible for administering the State child health plan under subchapter XXI (in this section referred to as the “State CHIP agency”) and an Exchange established by the State under section 18031 of this title utilize a secure electronic interface sufficient to allow for a determination of an individual’s eligibility for such medical assistance, child health assistance, or premium assistance, and enrollment in the State plan under this subchapter, subchapter XXI, or a qualified health plan, as appropriate;

(E)coordinating, for individuals who are enrolled in the State plan or under a waiver of the plan and who are also enrolled in a qualified health plan offered through such an Exchange, and for individuals who are enrolled in the State child health plan under subchapter XXI and who are also enrolled in a qualified health plan, the provision of medical assistance or child health assistance to such individuals with the coverage provided under the qualified health plan in which they are enrolled, including services described in section 1396d(a)(4)(B) of this title (relating to early and periodic screening, diagnostic, and treatment services defined in section 1396d(r) of this title) and provided in accordance with the requirements of section 1396a(a)(43) of this title; and

(F)conducting outreach to and enrolling vulnerable and underserved populations eligible for medical assistance under this subchapter or for child health assistance under subchapter XXI, including children, unaccompanied homeless youth, children and youth with special health care needs, pregnant women, racial and ethnic minorities, rural populations, victims of abuse or trauma, individuals with mental health or substance-related disorders, and individuals with HIV/AIDS.

(2)The State Medicaid agency and the State CHIP agency may enter into an agreement with an Exchange established by the State under section 18031 of this title under which the State Medicaid agency or State CHIP agency may determine whether a State resident is eligible for premium assistance for the purchase of a qualified health plan under section 36B of the Internal Revenue Code of 1986 (and, if applicable, advance payment of such assistance under section 18082 of this title), so long as the agreement meets such conditions and requirements as the Secretary of the Treasury may prescribe to reduce administrative costs and the likelihood of eligibility errors and disruptions in coverage.

(3)The State Medicaid agency and State CHIP agency shall participate in and comply with the requirements for the system established under section 18083 of this title (relating to streamlined procedures for enrollment through an Exchange, Medicaid, and CHIP).

(4)The procedures established by State under paragraph (1) shall include establishing and having in operation, not later than January 1, 2014, an Internet website that is linked to any website of an Exchange established by the State under section 18031 of this title and to the State CHIP agency (if different from the State Medicaid agency) and allows an individual who is eligible for medical assistance under the State plan or under a waiver of the plan and who is eligible to receive premium credit assistance for the purchase of a qualified health plan under section 36B of the Internal Revenue Code of 1986 to compare the benefits, premiums, and cost-sharing applicable to the individual under the State plan or waiver with the benefits, premiums, and cost-sharing available to the individual under a qualified health plan offered through such an Exchange, including, in the case of a child, the coverage that would be provided for the child through the State plan or waiver with the coverage that would be provided to the child through enrollment in family coverage under that plan and as supplemental coverage by the State under the State plan or waiver.

(5)Nothing in paragraph (1) shall limit or modify the requirement that the State assess an individual for purposes of providing home and community-based services under the State plan or under any waiver of such plan for individuals described in subsection (a)(10)(A)(ii)(VI).22 Probably means subsection (a)(10)(A)(ii)(VI) of section 1396a of this title.

Editorial Notes

References in Text

The Internal Revenue Code of 1986, referred to in subsec. (b)(1)(C), (2), (4), is classified generally to Title 26, Internal Revenue Code.

§1396w–3 Enrollment simplification and coordination with State health insurance exchanges

Summary

Title 42, §1396w–3

Notes & Related Subsidiaries

Editorial Notes

References in Text

Citations & Metadata